Case Manager Nurse Job Fairmont area,West Virginia USA,Nursing

Core Duties and Responsibilities

This position comprehensively plans for targeted patient populations. Performs resource management, including denial management, utilization management, access to the appropriate level of care, discharge planning, care facilitation, and referral to other levels of care. Works collaboratively with the multidisciplinary care team to facilitate achievement of desired treatment outcomes.

These statements describe the general nature of work performed by those assigned to this position. They are not an all-inclusive list, and other duties may be assigned.

Minimum Qualifications

Education, Certification, and/or Licensure:

Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).

Experience:

Three (3) years clinical experience.

Preferred Qualifications

Education, Certification, and/or Licensure:

Bachelor's degree in Nursing (BSN)

Core Duties and Responsibilities

Manages all aspects of transition/discharge planning for assigned patients in a timely manner.

Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.

Monitors the patient's progress; intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.

Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.

Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning.

Initiates and facilitates referrals to post-acute services— including but not limited to Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities.

Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.

Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.

Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives.

Collaborates for appropriate resource and financial management which may include but is not limited to financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.

Utilizes quality screens in the electronic record to identify potential issues including but not limited to avoidable delays and readmissions.

Completes clinical reviews for patients.

Applies approved utilization criteria to ensure medical necessity of patient's admissions and continued stays, and documents the findings based on department standards, policy and procedure.

Screens for appropriate authorization and level of care.

Facilitates covered day reimbursement certification for assigned patients and discusses payor criteria and issues on a case by case basis with clinical staff (ie. Peer to Peer) and follows up to resolve problems with payors as needed.

Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.

Fosters the integration of staff and/or students into the healthcare team.

For facilities with specialty accreditation requirements:

Completion of annual required education related to specialty accreditation as defined by accreditation standards. Training may be completed through CBLs, trainings, In‑services, and competency validation.

Physical Requirements

Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing nursing duties throughout the work shift.
Must be able to lift, move, and position patients of all weights, with varying amounts of assistance in a fair manner on a regular and recurring basis.
Hearing within a normal range required (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).
Visual acuity must be within normal range. Must be able to perform night driving as necessary for patient care.
Must be able to perform heavy work; exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

Working Environment

Working closely with others.
Working protracted or irregular hours.
Working around biohazards.
Working around infectious diseases.
Working with hands in water.
Working with electrical hazards associated with patient care equipment.

Skills and Abilities

Knowledge of patient's current medical…